摘要
目的探讨自动弹力线痔疮套扎器治疗重度混合痔患者术后创面愈合时间的影响因素。方法回顾性收集新疆维吾尔自治区第三人民医院2021年4月至2024年4月收治的406例重度混合痔患者的临床资料,术后创面愈合时间>10 d的157例为长周期组,≤10 d的249例为短周期组。比较两组患者临床资料,经多因素logistic回归分析影响创面愈合时间的因素并构建列线图模型。结果两组患者病灶直径、合并糖尿病、术前血清白蛋白、焦虑自评量表(SAS)评分、便秘、创面感染及异物反应比较差异均有统计学意义(均P<0.05)。排除方差膨胀因子值>5的因素后,多因素logistic回归分析发现病灶直径长、有便秘、有创面感染、SAS评分高均为术后创面愈合时间的危险因素(均P<0.05),而术前血清白蛋白水平高是术后创面愈合时间的保护因素(P<0.05)。列线图模型校准曲线与标准曲线接近,可靠性强;其预测术后创面愈合时间的AUC为0.997(95%CI:0.993~1.000),区分度好,具有预测价值。长周期组内痔组织残留、瘢痕挛缩、肛门狭窄的发生率均高于短周期组,复发率高于短周期组,差异均有统计学意义(均P<0.05)。结论病灶直径、便秘、创面感染、术前血清白蛋白水平及SAS评分对预测术后创面愈合情况有重要作用,临床应重视并尽早干预,以缩短愈合时间,促进患者康复。
Objective To investigate the factors influencing postoperative wound healing time in patients with severe mixed hemorrhoids treated with an automatic elastic band ligation device.Methods Clinical data of 406 patients with severe mixed hemorrhoids treated at the Third People's Hospital of Xinjiang Uygur Autonomous Region between April 2021 and April 2024 were retrospectively analyzed.Patients were divided into two groups based on wound healing time:157 cases with healing time>10 days(prolonged-healing group)and 249 cases with healing time≤10 days(normal-healing group).Clinical data were compared between the groups,and multivariate logistic regression was used to identify factors influencing wound healing time and to construct a nomogram prediction model.Results Significant differences were observed between the two groups in lesion diameter,diabetes comorbidity,preoperative serum albumin levels,Self-Rating Anxiety Scale(SAS)scores,constipation,wound infection,and foreign body reaction(all P<0.05).After excluding variables with a variance inflation factor>5,multivariate logistic regression identified larger lesion diameter,constipation,wound infection,and higher SAS scores as independent risk factors for prolonged wound healing time(all P<0.05),while higher preoperative serum albumin levels were a protective factor(P<0.05).The calibration curve of the nomogram model closely aligned with the standard curve,demonstrating strong reliability.The model achieved an AUC of 0.997(95%CI:0.993-1.000)for predicting postoperative wound healing time,indicating excellent discriminative ability and predictive value.The prolonged-healing group had significantly higher rates of residual internal hemorrhoidal tissue,scar contracture,anal stenosis,and recurrence compared to the normal-healing group(all P<0.05).Conclusion Lesion diameter,constipation,wound infection,preoperative serum albumin levels,and SAS scores are significant predictors of postoperative wound healing time.Early clinical intervention targeting these factors may help shorten healing time and promote patient recovery.
作者
华玉平
姜佳丽
陈泽军
李梦洁
HUA Yuping;JIANG Jiali;CHEN Zejun;LI Mengjie(Department of Anorectal Surgery,the Third People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)
出处
《浙江医学》
2025年第23期2503-2508,共6页
Zhejiang Medical Journal
关键词
自动弹力线痔疮套扎器
重度混合痔
创面愈合
列线图模型
Automatic elastic band ligation device
Severe mixed hemorrhoids
Wound healing
Nomogram model
